Negative Controls

We heard from a patient during our Dermatology week, who worked as a medical laboratory technician, running hundreds of blood samples every day, and frequently using her own blood as the negative control. Then she began to notice that the numbers stopped making sense. Her ANA had shot through the roof and her white blood cells started dropping.

“I couldn’t use my blood as the negative control anymore,” she said, shrugging slightly.

Her stoic face didn’t reveal much, but I imagine that being dethroned from the pristine world of negative controls into the confusing milieu of mucked up numbers and unsteady ground couldn’t have been an easy thing to accept.

She had lupus.

A few more things followed. A friend confessed to me that she didn’t particularly appreciate the accepted, if not expected, gallows humor that our classmates used in talking about diseases and disease states. Sure we all knew that we were teetering on the edge of propriety when we tried to remember the functions of the different cranial nerves by acting out their deficits, but there were good reasons! There were always good reasons. We were coping with the vulnerability of the body, the darkness of the world we encountered daily; we were only using humorous study techniques to process the huge quantities of information thrown at us; we were just being kids. We were joking. No harm, no foul.

But the friend protested the unspoken assumption that as medical students, as those on the other side of the patient-doctor relationship, we were well. Not many of us have cruised through life without ever having visited the realm of the ill, or perhaps seen a close family member or friend acquire such a passport.

One of my classmates in fact recently published a piece in JAMA’s A Piece of My Mind illustrating her experiences of going through medical school against the backdrop of cancer. Shekinah wrote about how medical students, like physicians, are imagined to be among the well. Professors reinforce this, calling us healthy for being young and presenting without ‘clinical findings’. “The mechanisms for heartbreak and loss are not on the docket of our formal education,” she wrote.

It’s not an easy balance to manage. Physicians don’t like to count themselves among their patients, despite the fact that they very well may be some other doctor’s patients. We value this dichotomy, this breathing space, this space to joke and fool around and talk about diseases and being ill without feeling vulnerable or sad. With the model of thinking that we’re all in this together, that any of us can be implicated, we lose that. There’s the idea that treating illness as something too sacred to tease would force us all to be politically correct at all times. That too much respect would lead to fear, and so on.

But I think that no one really requires either extreme. Acknowledgement can coexist with detachment, empathy with intellectual curiosity. To illustrate –

Another classmate recently told me that in her psychiatry small group, the physician prefaced a discussion of schizophrenia with a nod to the idea that no one in the group suffered from such a burden to the mind.

That. There’s the danger. That’s the logical leap in question. None of us are spared, now or later. To forget that is just not fair.